Everting of Retracting Patella during Total Knee Replacement?

Abstract

Background: Patellar retraction versus patellar eversion during total knee replacement (TKR) is a current controversial issue in the literature regarding postoperative pain, recovery of quadriceps function, component position, complications and differences in outcomes. Question: Is there any difference between retracting and everting the patella during TKR regarding the aforementioned parameters? Methods: A PubMed and Cochrane Library search was performed on 28 February 2014 using “eversion of patella” as keywords. Only nine prospective randomized studies focused on the question of this article were found. Results: Six papers analyzed postoperative pain; three of them did not find differences while three found differences in favor of retracting patella. Two papers studied recovery of quadriceps function. One of them found no difference while the other encountered better return of quadriceps function after patella retraction. Five papers analyzed component positioning. Four found no differences, while one encountered a higher rate of malposition in patellar retraction. Five articles studied complications resulting from either technique. Three of them encountered no differences. One found 2/60 intraoperative complications in patellar eversion, while the other found 2/50 cases of delayed wound healing in patellar retraction. Seven papers analyzed the short-term and long-term results. Two of them found no differences, but the other five encountered better ROM in patellar retraction. Conclusions: Retracting patella seems to be associated with better ROM, although no differences in component malposition between patellar eversion and patellar retraction have been found. Contradictory results have been encountered regarding postoperative knee pain, complications, and recovery of quadriceps power.